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Cerebro-Vascular Disease
Dr. Raid Jastania
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage
– Global ischemia
Cerebrovascular Disease
• 3rd leading cause of death• Vascular diseases:– Congenital/Developmental, Acquired– Acquired:• Localized
– Thrombosis– Embolism– Hemorrhage
• Global ischemia
Hypoxia, Ischemia, Infarction
• Hypoxia: reduction in oxygen supply• Ischemia: reduction in tissue perfusion• Infarction: necrosis due to hypoxia/ischemia
• Brain receives 15% of cardiac output• Brain consumes 20% of oxygen • Autoregulation of vascular resistance• Functional/Structural hypoxia
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage
– Global ischemia
Global Cerebral Ischemia• Generalized reduction in perfusion• Systolic pressure <50mmHg• Mild: transient injury• Moderate/Severe: permanent damage• Persistent Vegetative state• Brain Death• Changes:– Swelling, necrosis, neutrophils, macrophages, giolosis,
repair– Border zone (watershed) infarct
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage
– Global ischemia
Localized (Focal) Cerebral Ischemia• Occlusion of artery• Presence of collateral flow• Circle of Willis• Cortical-leptomeningeal anastomosis
• Thrombosis: in carotid athrosclerosis• Emboli: – MI, valve disease, atrial fibrillation, cardiac thrombi,
paradoxical emboli– Middle cerebral artery is the most frequent
Focal Cerebral Ischemia
• Infarction:– Non hemorrhagic– Hemorrhagic– Changes:• <6 hours: normal• 24 hours: necrosis, neutrophils, edema• 48 hours: pale, soft, swollen• 2-10 days: gelatinous, friable, macrophages• 10days-3weeks: liquifaction• >3 weeks: Gliosis, repair
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage
– Global ischemia
Intracarnial Hemorrhage
• Anatomical site:– Intraparenchymal– subarachnoid– Subdural– Epidural
• Cause:– Bleeding disorder– Primary vessel disease:
• Developmental: berry aneurysm
• Acquired: Vasculitis– Secondary vessel
disease: • Hypertension• Amyloid angiopathy
– Trauma, tumor, inflammtion
Subarachnoid Hemorrhage
• Causes:– Saccular (berry) aneurysm– A-V malformation– Trauma– Tumors
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage
– Global ischemia
Berry Aneurysm
Berry Aneurysm
• Can be congenital• Most appear later in life• Risk of bleeding: if 10mm size, risk 50% bleed• 20-30% have multiple aneurysms• 90% in the anterior circulation at the circle of
Willis• 25-50% risk of death if rupture• Headache, increase ICP, loss of consciousness
Vascular Malformation
• Arterio Venous Malformation (A-V malforamtion)
• Cavernous angioma• Capillary telangeictasia• Venous angioma
A-V malformation
• male > female• 10-30 years of age• Seizure, hemorrhage, sometimes CHF
Intraparenchymal Hemorrhage
• Peak: 60 years of age• Rupture of intraparenchymal vessels• Hypertension: basal ganglia, thalamus, pons,
cerebellum• Cerebral Amyloid Angiopathy: leptomeningeal
and cortical vessles
Hypertensive cerebrovascular disease
• Slit hemorrhage• Lacunar infarct• Intracerebral hemorrhage• Hypertesive encephalopathy
Hypertensive cerebrovascular disease
• Changes:– Hyaline arteriolar sclerosis– Weak arteriols– Aneurysm (Charcot-Bouchard microaneurysm– Lacunar infarct: small cavity in basal ganglia,
thalamus, pons– Encephalopathy: headache, confusion, vomiting,
convulsions, coma
Vasculitis
Summary
• Cerebrovascular disease– Congenital/Developmental– Acquired
– Localized lesion:• Blockage
– Thrombosis– Emboli
• Hemorrhage– Global ischemia
Intracarnial Hemorrhage
• Anatomical site:– Intraparenchymal– subarachnoid– Subdural– Epidural
• Cause:– Bleeding disorder– Primary vessel disease:
• Developmental: berry aneurysm
• Acquired: Vasculitis– Secondary vessel
disease: • Hypertension• Amyloid angiopathy
– Trauma, tumor, inflammtion
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